1.Mechanism of bilobalide promoting neuroprotection of macrophages.
Yang-Yang CHEN ; Wen-Yuan JU ; Guo-Guo CHU ; Xiao-Hui LI ; Ru-Heng WEI ; Qing WANG ; Bao-Guo XIAO ; Cun-Gen MA
China Journal of Chinese Materia Medica 2023;48(15):4201-4207
		                        		
		                        			
		                        			This study aims to explore the neuroprotective effect of bilobalide(BB) and the mechanisms such as inhibiting inflammatory response in macrophage/microglia, promoting neurotrophic factor secretion, and interfering with the activation and differentiation of peripheral CD4~+ T cells. BB of different concentration(12.5, 25, 50, 100 μg·mL~(-1)) was used to treat the RAW264.7 and BV2 cells for 24 h. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide(MTT) assay and cell counting kit-8(CCK-8) were employed to detect the cytotoxicity of BB and appropriate concentration was selected for further experiment. Lipopolysaccharide(LPS) was applied to elicit inflammation in RAW264.7 and BV2 cells, mouse bone marrow-derived macrophages(BMDMs), and primary microglia, respectively. The effect of BB on cell proliferation and secretion of inflammatory cytokines and neurotrophic factors was detected by enzyme-linked immunosorbent assay(ELISA). Spleen monocytes of C57BL/6 female mice(7-8 weeks old) were isolated, and CD4~+ T cells were separated by magnetic beads under sterile conditions. Th17 cells were induced by CD3/CD28 and the conditioned medium for eliciting the inflammation in BMDMs. The content of IL-17 cytokines in the supernatant was detected by ELISA to determine the effect on the activation and differentiation of CD4~+ T cells. In addition, PC12 cells were incubated with the conditioned medium for eliciting inflammation in BMDMs and primary microglia and the count and morphology of cells were observed. The cytoto-xicity was determined by lactate dehydrogenase(LDH) assay. The result showed that BB with the concentration of 12.5-100 μg·mL~(-1) had no toxicity to RAW264.7 and BV2 cells, and had no significant effect on the activity of cell model with low inflammation. The 50 μg·mL~(-1) BB was selected for further experiment, and the results indicated that BB inhibited LPS-induced secretion of inflammatory cytokines. The experiment on CD4~+ T cells showed that the conditioned medium for LPS-induced inflammation in BMDMs promoted the activation and differentiation of CD4~+ T cells, while the conditioned medium of the experimental group with BB intervention reduced the activation and differentiation of CD4~+ T cells. In addition, BB also enhanced the release of neurotrophic factors from BMDMs and primary microglia. The conditioned medium after BB intervention can significantly reduce the death of PC12 neurons, inhibit neuronal damage, and protect neurons. To sum up, BB plays a neuroprotective role by inhibiting macrophage and microglia-mediated inflammatory response and promoting neurotrophic factors.
		                        		
		                        		
		                        		
		                        			Female
		                        			;
		                        		
		                        			Rats
		                        			;
		                        		
		                        			Mice
		                        			;
		                        		
		                        			Animals
		                        			;
		                        		
		                        			Bilobalides/pharmacology*
		                        			;
		                        		
		                        			Neuroprotection
		                        			;
		                        		
		                        			Lipopolysaccharides/toxicity*
		                        			;
		                        		
		                        			Culture Media, Conditioned/pharmacology*
		                        			;
		                        		
		                        			Mice, Inbred C57BL
		                        			;
		                        		
		                        			Macrophages/metabolism*
		                        			;
		                        		
		                        			Microglia
		                        			;
		                        		
		                        			Cytokines/metabolism*
		                        			;
		                        		
		                        			Nerve Growth Factors/pharmacology*
		                        			;
		                        		
		                        			Inflammation/metabolism*
		                        			
		                        		
		                        	
2.Effect of electroacupuncture on visceral sensitivity and colonic NGF, TrkA, TRPV1 expression in IBS-D rats.
Yi-Chen YANG ; Zi-Xian ZHOU ; Ting XUE ; Yuan-Hui FENG ; Jun-Tao CHEN ; Tu-Nan WANG ; Jia-Yu ZHAO ; Liu-Jing WANG ; Peng ZHANG ; Li-Ping ZHANG ; Hui-Fang MA
Chinese Acupuncture & Moxibustion 2022;42(12):1395-1402
		                        		
		                        			OBJECTIVE:
		                        			To observe the effect of electroacupuncture (EA) at "Tianshu" (ST 25) and "Shangjuxu" (ST 37) on mental state, visceral sensitivity and protein expression of nerve growth factor (NGF), tyrosine kinase receptor A (TrkA) and transient receptor potential vanilloid 1 (TRPV1) of colonic tissue in diarrhea-predominant irritable bowel syndrome (IBS-D) rats, and to explore its possible mechanism on treating IBS-D.
		                        		
		                        			METHODS:
		                        			A total of 36 male SD rats of SPF grade were randomized into a blank group, a model group, an EA group and a western medication group, 9 rats in each group. In the model group, the EA group and the western medication group, IBS-D model was established by enema of dinitrobenzene sulfonic acid (DNBS) combined with chronic restraint stress method. In the EA group, EA was applied at "Tianshu" (ST 25) and "Shangjuxu" (ST 37), with disperse-dense wave, in frequency of 2 Hz/100 Hz, 20 min each time, once a day for 7 days. In the western medication group, pinaverium bromide suspension was given by gavage (15 mg•kg-1•d-1) for 7 days. Before and after model establishment, and after intervention, the body mass, 24 h food intake and fecal water content were observed, the visceral sensitivity was detected by abdominal withdrawal reflex (AWR); after intervention, the mental state was evaluated by elevated plus maze (EPM) test, the protein expression of NGF, TrkA and TRPV1 was detected by immunohistochemistry and Western blot in the 4 groups.
		                        		
		                        			RESULTS:
		                        			After model establishment, compared with the blank group, the body mass and 24 h food intake were decreased (P<0.05), first systolic latency of AWR was shortened and number of contraction wave of AWR was increased (P<0.05), and fecal water content was increased (P<0.05) in the model group, the EA group and the western medication group. After intervention, compared with the blank group, open arm residence time ratio (OT%) of EPM was decreased (P<0.05) and protein expression of NGF, TrkA, TRPV1 in colonic tissue was increased in the model group (P<0.05); compared with the model group, the body mass and 24 h food intake were increased (P<0.05), first systolic latency of AWR was lengthened and number of contraction wave of AWR was decreased (P<0.05), the fecal water content was decreased (P<0.05), OT% of EPM was increased (P<0.05), and protein expression of NGF, TrkA, TRPV1 in colonic tissue was decreased (P<0.05) in the EA group and the western medication group.
		                        		
		                        			CONCLUSION
		                        			Electroacupuncture at "Tianshu" (ST 25) and "Shangjuxu" (ST 37) can relieve the anxiety and depression-like behaviors in IBS-D rats, down-regulate the protein expression of NGF, TrkA, TRPV1 in colonic tissue, so as to reduce the visceral sensitivity and relieve symptoms.
		                        		
		                        		
		                        		
		                        			Male
		                        			;
		                        		
		                        			Rats
		                        			;
		                        		
		                        			Animals
		                        			;
		                        		
		                        			Receptor Protein-Tyrosine Kinases
		                        			;
		                        		
		                        			Rats, Sprague-Dawley
		                        			;
		                        		
		                        			Irritable Bowel Syndrome/therapy*
		                        			;
		                        		
		                        			Sulfonic Acids
		                        			;
		                        		
		                        			Nerve Growth Factors
		                        			;
		                        		
		                        			TRPV Cation Channels/genetics*
		                        			
		                        		
		                        	
3.Study of neurotrophic factor receptor tyrosine kinase gene fusion in the precise treatment of wild-type gastrointestinal stromal tumor.
Hai Dong ZHANG ; Xiao Nan YIN ; Zhao Lun CAI ; Bo ZHANG
Chinese Journal of Gastrointestinal Surgery 2021;24(9):769-774
		                        		
		                        			
		                        			The neurotrophin receptor kinase (NTRK) gene encodes neurotrophic factor receptor tyrosine kinase (NTRK), which plays an important role in the development and function of the nervous system. NTRK gene fusion mutation results in the production of chimeric NTRK proteins, which have carcinogenic potential through constitutive activation or overexpression. NTRK gene fusion mutation can lead to a special type of wild type gastrointestinal stromal tumor (GIST), whose clinical manifestations and treatment are completely different from other types of GIST. This fusion mutation can be detected clinically by a variety of methods, including tumor DNA and RNA sequencing and immunohistochemical staining. In patients with NTRK fusion positive tumors, NTRK inhibitors such as larotrectinib and entrectinib have shown good antitumor efficacy, with clinical response rates as high as 75%. Therefore, there is a need to improve the recognition and detection of fuch patients and to improve their prognosis by individualized and precise treatment with TRK inhibitors.
		                        		
		                        		
		                        		
		                        			Gastrointestinal Stromal Tumors/genetics*
		                        			;
		                        		
		                        			Gene Fusion
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Neoplasms
		                        			;
		                        		
		                        			Nerve Growth Factors
		                        			;
		                        		
		                        			Protein Kinase Inhibitors
		                        			;
		                        		
		                        			Receptor, trkA/genetics*
		                        			;
		                        		
		                        			Receptors, Nerve Growth Factor/genetics*
		                        			
		                        		
		                        	
4.Effects of Pigment Epithelium-derived Factor and Its Peptides on Proliferation, Apoptosis and Migration of Non-small Cell Lung Cancer.
Zhixiang CHAO ; Xichun QIN ; Caili JIA ; Hao QIN ; Hao ZHANG
Chinese Journal of Lung Cancer 2021;24(12):829-837
		                        		
		                        			BACKGROUND:
		                        			The anti-tumor effect of pigment epithelium-derived factor (PEDF) has been widely confirmed. However, the anti-tumor effect of its peptides is rarely reported. This study aims to investigate the effects of PEDF and its peptides on the apoptosis and migration of non-small cell lung cancer (NSCLC).
		                        		
		                        			METHODS:
		                        			In this study, A549 cells and H1299 cells were selected as the research object, and the cells were divided into normal group, PEDF treatment group, 34 peptide treatment group, 44 peptide treatment group and 34+44 peptide treatment group by administering different drugs at the same concentration to the cells. The proliferation activity of cells in each group was detected by CCK-8 method; the migration ability of cells was detected by scratch test; the expression levels of apoptosis related proteins such as protein kinase 3 (RIP3) and cleaved-caspase-3 were detected by Western blot; the expression levels of epithelial mesenchymal transition (EMT) markers in each group, such as cadherin (E-cadherin) and α-smooth muscle actin (α-SMA) were detected by Western blot; the apoptosis rate of each group was detected by flow cytometry.
		                        		
		                        			RESULTS:
		                        			The results of CCK-8 showed that PEDF and its peptides could inhibit cell proliferation, and the inhibitory effect of 34+44 peptide was the strongest (P<0.05); Observation under the microscope found that PEDF and its peptides can inhibit the proliferation and mesenchymal transformation of A549 cells and H1299 cells, and the inhibitory effect of the 34+44 peptide group is the most obvious; Western blot indicated that compared with other groups, the expressions of cleaved-caspase-3 and RIP3 in 34+44 peptide group were significantly higher (P<0.05), and the expressions of EMT protein E-cadherin were higher, the expression of α-SMA decreased (P<0.05); The results of flow cytometry showed that the apoptosis rate of 34+44 peptide group was significantly higher than those of other groups (P<0.05); The scratch test showed that compared with all the other groups, the healing rate of 34+44 peptide group was the lowest (P<0.05).
		                        		
		                        			CONCLUSIONS
		                        			34+44 combination peptide can better promote the apoptosis of NSCLC, inhibit the migration of NSCLC, and thereby inhibit the growth of NSCLC.
		                        		
		                        		
		                        		
		                        			Apoptosis
		                        			;
		                        		
		                        			Cadherins/genetics*
		                        			;
		                        		
		                        			Carcinoma, Non-Small-Cell Lung/genetics*
		                        			;
		                        		
		                        			Caspase 3
		                        			;
		                        		
		                        			Cell Line, Tumor
		                        			;
		                        		
		                        			Cell Movement
		                        			;
		                        		
		                        			Cell Proliferation
		                        			;
		                        		
		                        			Epithelial-Mesenchymal Transition
		                        			;
		                        		
		                        			Eye Proteins
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Lung Neoplasms/genetics*
		                        			;
		                        		
		                        			Nerve Growth Factors
		                        			;
		                        		
		                        			Peptides/pharmacology*
		                        			;
		                        		
		                        			Serpins
		                        			;
		                        		
		                        			Sincalide
		                        			
		                        		
		                        	
5.Evidence for the Presence of Long-Lived Plasma Cells in Nasal Polyps
Ya Na ZHANG ; Jia SONG ; Guan Ting ZHAI ; Hai WANG ; Ren Zhong LUO ; Jing Xian LI ; Bo LIAO ; Jin MA ; Heng WANG ; Xiang LU ; Da Bo LIU ; Zheng LIU
Allergy, Asthma & Immunology Research 2020;12(2):274-291
		                        		
		                        			
		                        			PURPOSE: Plasma cells and immunoglobulins (Igs) play a pivotal role in the induction and maintenance of chronic inflammation in nasal polyps. During secondary immune responses, plasma cell survival and Ig production are regulated by the local environment. The purpose of the present study was to investigate the presence of long-lived plasma cells (LLPCs) and specific survival niches for LLPCs in human nasal polyps.METHODS: Nasal mucosal samples were cultured with an air-liquid interface system and the Ig levels in culture supernatants were analyzed by enzyme-linked immunosorbent assay. The characteristics of LLPCs in nasal polyps were determined by immunohistochemistry and immunofluorescence. The expression of neurotrophins as well as their receptors was detected by quantitative real-time polymerase chain reaction, immunohistochemistry, immunofluorescence, and Western blotting.RESULTS: The numbers of CD138⁺ total plasma cells and BCL2⁺ plasma cells were increased in both eosinophilic and non-eosinophilic nasal polyps compared with those in normal tissues. The production of IgG, IgA, and IgE was detected in culture supernatants even after a 32-day culture of nasal polyps. Although the total numbers of plasma cells were decreased in nasal polyps after culture, the numbers of BCL2⁺ plasma cells remained stable. The expression of nerve growth factor (NGF) as well as tropomyosin receptor kinase (Trk) A, a high-affinity receptor for NGF, was upregulated in both eosinophilic and non-eosinophilic nasal polyps. In addition, BCL2⁺ plasma cell numbers were positively correlated with NGF and TrkA mRNA expression in nasal mucosal tissues. Polyp plasma cells had the expression of TrkA.CONCLUSIONS: Human nasal polyps harbor a population of LLPCs and NGF may be involved in their prolonged survival. LLPCs may be a novel therapeutic target for suppressing the local Ig production in nasal polyps.
		                        		
		                        		
		                        		
		                        			Blotting, Western
		                        			;
		                        		
		                        			Enzyme-Linked Immunosorbent Assay
		                        			;
		                        		
		                        			Eosinophils
		                        			;
		                        		
		                        			Fluorescent Antibody Technique
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Immunoglobulin A
		                        			;
		                        		
		                        			Immunoglobulin E
		                        			;
		                        		
		                        			Immunoglobulin G
		                        			;
		                        		
		                        			Immunoglobulins
		                        			;
		                        		
		                        			Immunohistochemistry
		                        			;
		                        		
		                        			Inflammation
		                        			;
		                        		
		                        			Mucous Membrane
		                        			;
		                        		
		                        			Nasal Polyps
		                        			;
		                        		
		                        			Nerve Growth Factor
		                        			;
		                        		
		                        			Nerve Growth Factors
		                        			;
		                        		
		                        			Phosphotransferases
		                        			;
		                        		
		                        			Plasma Cells
		                        			;
		                        		
		                        			Plasma
		                        			;
		                        		
		                        			Polyps
		                        			;
		                        		
		                        			Real-Time Polymerase Chain Reaction
		                        			;
		                        		
		                        			RNA, Messenger
		                        			;
		                        		
		                        			Tropomyosin
		                        			
		                        		
		                        	
6.Stem cell therapy in pain medicine
Yong Hee HAN ; Kyung Hoon KIM ; Salahadin ABDI ; Tae Kyun KIM
The Korean Journal of Pain 2019;32(4):245-255
		                        		
		                        			
		                        			Stem cells are attracting attention as a key element in future medicine, satisfying the desire to live a healthier life with the possibility that they can regenerate tissue damaged or degenerated by disease or aging. Stem cells are defined as undifferentiated cells that have the ability to replicate and differentiate themselves into various tissues cells. Stem cells, commonly encountered in clinical or preclinical stages, are largely classified into embryonic, adult, and induced pluripotent stem cells. Recently, stem cell transplantation has been frequently applied to the treatment of pain as an alternative or promising approach for the treatment of severe osteoarthritis, neuropathic pain, and intractable musculoskeletal pain which do not respond to conventional medicine. The main idea of applying stem cells to neuropathic pain is based on the ability of stem cells to release neurotrophic factors, along with providing a cellular source for replacing the injured neural cells, making them ideal candidates for modulating and possibly reversing intractable neuropathic pain. Even though various differentiation capacities of stem cells are reported, there is not enough knowledge and technique to control the differentiation into desired tissues in vivo. Even though the use of stem cells is still in the very early stages of clinical use and raises complicated ethical problems, the future of stem cells therapies is very bright with the help of accumulating evidence and technology.
		                        		
		                        		
		                        		
		                        			Adult
		                        			;
		                        		
		                        			Adult Stem Cells
		                        			;
		                        		
		                        			Aging
		                        			;
		                        		
		                        			Cell Differentiation
		                        			;
		                        		
		                        			Embryonic Stem Cells
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Induced Pluripotent Stem Cells
		                        			;
		                        		
		                        			Musculoskeletal Pain
		                        			;
		                        		
		                        			Nerve Growth Factors
		                        			;
		                        		
		                        			Neuralgia
		                        			;
		                        		
		                        			Osteoarthritis
		                        			;
		                        		
		                        			Stem Cell Transplantation
		                        			;
		                        		
		                        			Stem Cells
		                        			
		                        		
		                        	
7.Neurobiological understanding of suicide
Journal of the Korean Medical Association 2019;62(2):85-92
		                        		
		                        			
		                        			Suicide is a complex phenomenon resulting from interactions between individual vulnerabilities and socio-environmental factors. The current review primarily focuses on research into the serotonin system, hypothalamic-pituitary-adrenal axis, neurotrophic factors, lipid metabolism, and functional neuroimaging studies. It has been found that dysfunctions in the serotonin system, hypothalamic-pituitary-adrenal axis abnormalities, and low brain-derived neurotrophic factor and cholesterol levels may be linked to suicide. Additionally, recent neuroimaging studies have suggested that structural and functional abnormalities in brain areas related to cognitive and emotional regulation may be associated with suicide. More research incorporating advanced methodological approaches may shed further light on the neurobiological basis of suicide.
		                        		
		                        		
		                        		
		                        			Brain
		                        			;
		                        		
		                        			Brain-Derived Neurotrophic Factor
		                        			;
		                        		
		                        			Cholesterol
		                        			;
		                        		
		                        			Functional Neuroimaging
		                        			;
		                        		
		                        			Lipid Metabolism
		                        			;
		                        		
		                        			Nerve Growth Factors
		                        			;
		                        		
		                        			Neurobiology
		                        			;
		                        		
		                        			Neuroimaging
		                        			;
		                        		
		                        			Pituitary-Adrenal System
		                        			;
		                        		
		                        			Serotonin
		                        			;
		                        		
		                        			Suicide
		                        			
		                        		
		                        	
8.A Novel Bio-Psychosocial-Behavioral Treatment Model of Panic Disorder
Psychiatry Investigation 2019;16(1):4-15
		                        		
		                        			
		                        			To conceptualize a novel bio-psychosocial-behavioral treatment model of panic disorder (PD), it is necessary to completely integrate behavioral, psychophysiological, neurobiological, and genetic data. Molecular genetic research on PD is specifically focused on neurotransmitters, including serotonin, neuropeptides, glucocorticoids, and neurotrophins. Although pharmacological interventions for PD are currently available, the need for more effective, faster-acting, and more tolerable pharmacological interventions is unmet. Thus, glutamatergic receptor modulators, orexin receptor antagonists, corticotrophin-releasing factor 1 receptor antagonists, and other novel mechanism-based anti-panic therapeutics have been proposed. Research on the neural correlates of PD is focused on the dysfunctional “cross-talk” between emotional drive (limbic structure) and cognitive inhibition (prefrontal cortex) and the fear circuit, which includes the amygdala-hippocampus-prefrontal axis. The neural perspective regarding PD supports the idea that cognitive-behavioral therapy normalizes alterations in top-down cognitive processing, including increased threat expectancy and attention to threat. Consistent with the concept of “personalized medicine,” it is speculated that Research Domain Criteria can enlighten further treatments targeting dysfunctions underlying PD more precisely and provide us with better definitions of moderators used to identify subgroups according to different responses to treatment. Structuring of the “negative valence systems” domain, which includes fear/anxiety, is required to define PD. Therefore, targeting glutamate- and orexin-related molecular mechanisms associated with the fear circuit, which includes the amygdala-hippocampus-prefrontal cortex axis, is required to define a novel bio-psychosocial-behavioral treatment model of PD.
		                        		
		                        		
		                        		
		                        			Glucocorticoids
		                        			;
		                        		
		                        			Molecular Biology
		                        			;
		                        		
		                        			Nerve Growth Factors
		                        			;
		                        		
		                        			Neuropeptides
		                        			;
		                        		
		                        			Neurotransmitter Agents
		                        			;
		                        		
		                        			Orexin Receptor Antagonists
		                        			;
		                        		
		                        			Panic Disorder
		                        			;
		                        		
		                        			Panic
		                        			;
		                        		
		                        			Serotonin
		                        			
		                        		
		                        	
9.The Efficacy and Underlying Mechanism of Moxibustion in Preventing Cognitive Impairment: A Systematic Review of Animal Studies
Seon CHOE ; Mudan CAI ; Ui Min JERNG ; Jun Hwan LEE
Experimental Neurobiology 2018;27(1):1-15
		                        		
		                        			
		                        			Cognitive impairment is age-related and manageable only with early diagnosis and prevention. Moxibustion is widely accepted in East Asia as useful for preventing cognitive impairment. This systematic review of animal studies was conducted to verify the efficacy of moxibustion in preventing cognitive impairment and to elucidate the underlying mechanism. Randomized controlled animal trials that established the efficacy of moxibustion in preventing cognitive impairment were included in the analysis. Results of behavioral tests and the signaling pathways elucidated were extracted and a meta-analysis was conducted with the behavioral test results. The risk of bias was evaluated using 9 items, and reporting quality was evaluated using the ARRIVE (Animal Research: Reporting In Vivo Experiments) Guidelines Checklist. Ten trials involving 410 animals met the inclusion criteria. All studies reported the benefit of moxibustion in preventing cognitive deficits caused by Alzheimer's disease (AD). Among five studies using the Morris water maze test, a significant effect of moxibustion in decreasing the escape time was reported in three studies, increasing the crossing times in four studies, and prolonging the dwelling time in two studies. The effects of moxibustion were demonstrated to be mediated by an increase in the activity of neurotrophins and heat shock protein, modulation of the cell cycle, and suppression of apoptosis and inflammation. However, considering the small number of included studies, the lack of studies investigating entire signaling pathways, and a high risk of bias and low reporting quality, our results need to be confirmed through more detailed studies.
		                        		
		                        		
		                        		
		                        			Alzheimer Disease
		                        			;
		                        		
		                        			Animal Experimentation
		                        			;
		                        		
		                        			Animals
		                        			;
		                        		
		                        			Apoptosis
		                        			;
		                        		
		                        			Behavior Rating Scale
		                        			;
		                        		
		                        			Bias (Epidemiology)
		                        			;
		                        		
		                        			Cell Cycle
		                        			;
		                        		
		                        			Checklist
		                        			;
		                        		
		                        			Cognition Disorders
		                        			;
		                        		
		                        			Early Diagnosis
		                        			;
		                        		
		                        			Far East
		                        			;
		                        		
		                        			Heat-Shock Proteins
		                        			;
		                        		
		                        			Inflammation
		                        			;
		                        		
		                        			Moxibustion
		                        			;
		                        		
		                        			Nerve Growth Factors
		                        			;
		                        		
		                        			United Nations
		                        			;
		                        		
		                        			Water
		                        			
		                        		
		                        	
10.Rapid-Acting Antidepressant Effect of Ketamine and Its Clinical Application.
Journal of Korean Neuropsychiatric Association 2018;57(2):108-118
		                        		
		                        			
		                        			Although the biological causes of depression have been well established, the current use of antidepressants are still mostly based on the monoamine hypothesis of depression. However, monoamine antidepressants delay treatment of depression, and there is the problem of depressed patients who are resistant. Ketamine, a N-methyl-D-aspartate receptor (NMDAR) antagonist, is firstly introduced as an anesthetic. The hypothesis on the mechanism of ketamine as an antidepressant has been proposed through direct NMDAR inhibition, inhibition of γ-aminobutyric acid-ergic interneuron NMDARs and the role of ketamine metabolite (2R,6R)-hydroxynorcetamine (HNK). The ketamine also reverses the lack of synaptic connectivity and neurotrophic factors in depressed states by downstream mechanism of action. Through preclinical trials, there is a growing body of evidence indicating that ketamine has the potential for treatment of depression. In recent clinical studies, ketamine exhibits rapid-acting antidepressants effects and improvement of depression and even suicidality. This review examines current researches on molecular and cellular mechanisms of ketamine as an antidepressant, and reviews the current status of clinical studies, problems, and clinical applicability of ketamine.
		                        		
		                        		
		                        		
		                        			Antidepressive Agents
		                        			;
		                        		
		                        			Depression
		                        			;
		                        		
		                        			Glutamic Acid
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Interneurons
		                        			;
		                        		
		                        			Ketamine*
		                        			;
		                        		
		                        			N-Methylaspartate
		                        			;
		                        		
		                        			Nerve Growth Factors
		                        			
		                        		
		                        	
            
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